An abortion is a personal and emotional loss to a young couple who is planning to start a family. When this problem occurs repeatedly the emotional trauma is compounded manifold.
Definition : Any pregnancy loss before 20 weeks of gestation (4 completed months) is called an abortion. It is further divided into
Early losses (Embryonic i.e. before 9 weeks or one month after missed period) Embryonic losses occur before the full development of baby and are associated with genetic abnormalities in the baby. This type of abortion is generally associated with a small or delayed appearance of gestational sac in ultrasound, empty gestational sac or non-appearance of cardiac pulse.
Late abortions (fetal i.e. from 9 weeks to 20 weeks of pregnancy)
Late abortions more commonly occur due to other factors like abnormalities in the uterus or immunological factors which I am going to describe in detail.
Risk of recurrence
: The two most common questions asked after abortion Are why it occurred? And what are the chances of recurrence?
15 ? 25 % of all pregnancies end up in abortions. One sporadic abortion generally does not increase the risk of repeated abortion. Only about 1% of women have recurrent abortions on two or more than two occasions. Risk increases with the number of abortions a woman has.
Causes of Recurrent abortion
Genetic Factor : Almost 40-50% of all early losses are due to genetic abnormalities in the baby. These pregnancies are terminated by nature itself as a defence mechanism against the birth of abnormal babies. Chromosomal investigation of the couple may reveal abnormalities (only in 2-3 % of couple) in any of the parent. A pregnancy with donor egg or sperm may be the only answer.
Hormonal Factor : Deficiency of progesterone or luteal phase deficiency is a common problem especially in patients who conceive with the help of ovulation inducing agents and ART. Hormonal support is very important during first three months of pregnancy.
Abnormalities in thyroid status and diabetes can also lead to abortion. However these are treatable causes and with appropriate control of thyroid and diabetes pregnancy outcome is almost normal.Anatomic Factor : Abnormal shape of the uterus by birth such as a septum, Double uterus or fibroids can be a cause of late abortion. The cavity of uterus can get short due to sticking of walls of the uterus (intra-uterine adhesions) and lead to abortion. A loose cervix (mouth of the womb) is sometime not able to hold a normal pregnancy. All these conditions can be successfully treated by operations.
Immunological Factor : There are certain antibodies in the blood which affect or harm the normal tissues of the bodies. These are called auto antibodies. Of several such antibodies few have been found to be associated with recurrent abortion. Common ones are lupus anticoagulant (LA) and anti cardiolipin antibodies (ACL) others such as ANF, antithyroid and many others do not have a clear correlations with the problem of recurrent abortion. Treatment with low molecular weight heparin and aspirin is quite effective.
Other factors such as HLA type, TNF ? alpha and NK cells have also been investigated. Treatment with leukocyte immunotherapy and intravenous immunoglobulin have been tried but not found to efficacious.
Infections : There is some evidence that genital infection by
Chlamydia and TB can cause recurrent abortion. However, TORCH organisms which were considered a few years ago as important cause of recurrent abortion are no longer considered responsible. Even testing for TORCH is not recommended.
Co-agulation Disorders : Deficiencies of certain blood clotting factors lead to a thick blood and lead to recurrent loss due to clogging of blood vessels going to the baby. Treatment with blood thinning agents such as LMWH is quite effective.
Lifestyle Issues: Smoking, drinking and obesity, the traid of modern life-style do increase the risk of abortions.
Common Myths : Normal activity, dietary factors, stairs, sex, travel usually does not lead to abortions, a normal pregnancy can not be disturbed by these. A weak or unstable pregnancy does need extra rest and avoidance of any stress.
With good support, rest, hormones and specific operations in certain cases most of the women with recurrent abortions can achieve a successful pregnancy outcome.
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